Individual provider Active NPI

Kristine Marshall, D.D.S.

  • General Practice Dentistry
  • Clearwater, FL
National Provider Identifier
1396897385
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0013561 Issued in FL
Practice address
2325 Ulmerton Rd
Suite 27
Clearwater, FL 33762-2282
Phone
(727) 561-0800
Fax
(727) 561-0811
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0013561 FL Primary

Addresses

Primary practice location

2325 Ulmerton Rd
Suite 27
Clearwater, FL 33762-2282

Mailing address

7873 10TH Ave S
St Petersburg, FL 33707-2701
Phone (813) 731-8590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170920000428 FL Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 0446524185

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0013561FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Gotsmile, Inc CurrentSince Nov 1, 2017 Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396897385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7873 10TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337072701",
            "telephone_number": "813-731-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 ULMERTON RD",
            "address_2": "SUITE 27",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337622282",
            "telephone_number": "727-561-0800",
            "fax_number": "727-561-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "0013561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.